Contract QC Analyst

Profile

TriWest Healthcare Alliance offers remote work opportunities in AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only. Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

As a Contract QC Analyst, you will support the Supervisor of Provider Systems & Quality by performing quality control activities on provider contract and data records processed by the Provider Data and Contracting teams. This role is crucial for ensuring the integrity and accuracy of provider contract elements and data information. You will coordinate internal review and audit processes, monitor production and quality goals, and identify process improvements to enhance contracting data and staff quality standards.

Education & Experience

Required:

• High school diploma or G.E.D.
• 3 years’ experience working with contracting or provider data
• Experience in interpreting policies, monitoring compliance, or developing contract management processes
• Working knowledge of the provider contracting process

Preferred:

• Bachelor's degree in Business, Health Care Administration, Data Analysis, or related field
• Lead role over a process
• Experience with Emptoris or other contracting applications
• Experience with Provider Data Management Systems

Key Responsibilities

• Maintains all audit tools for internal and external audits.
• Assists in conducting daily, weekly, and monthly audits of contract and data staff.
• Monitors accuracy of the provider contract and data by conducting periodic audits.
• Collaborates with multiple business partners including Contracting Administration, Corporate Compliance, Claims Administration, and Legal to create strategies for contract templates and proactively prevent non-compliance.
• Manages executed contracts and amendments across multiple channels of the healthcare business.
• Develops and monitors quality reports and communications using contracting and provider data management systems.
• Assists in producing trend reports to improve workflow efficiency and system functions, recommending possible solutions to management.
• Assists with resolving data quality issues by identifying, documenting, and communicating quality issues.
• Assists with performing root cause analysis.
• Provides subject matter expertise.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

• Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.
• Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
• Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
• Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.
• Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.
• Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
• High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
• Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
• Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
• Technical Skills: Healthcare and/or Managed Care experience; working knowledge of Medicare requirements, URAC standards and State and Federal Regulations; working knowledge of TriWest policies and procedures; current knowledge of Contract Management, Contract Negotiation and Templates, Internal Process Improvement, and medical terminology; knowledge of contracting and provider data management systems; proficient with Word, Excel, and data management systems.

Working Conditions

• Availability to work any shift
• Works within a standard office environment, with minimal travel
• Department of Defense security clearance required

Company Overview

At TriWest Healthcare Alliance, we're on a mission to serve America's heroes by connecting them to health care in the community. We've proudly been on this important mission since 1996.

Benefits

TriWest Healthcare Alliance values teamwork and offers a comprehensive and progressive compensation and benefits package including Medical, Dental and Vision Coverage, Paid time off, 401(k) Retirement Savings Plan (with matching), Short-term and long-term disability, basic life, and accidental death and dismemberment insurance, Tuition reimbursement, and Paid volunteer time. You may also be considered for frequent pay raises, overtime opportunities, and recognition programs.

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $50,000 - $56,000 per year.

Key skills/competency

• Contract Management
• Provider Data
• Quality Control
• Auditing & Compliance
• Process Improvement
• Data Integrity
• Healthcare Regulations
• Root Cause Analysis
• Report Generation
• Microsoft Office Suite